16. 结合技能促进改变过程

综合技能以促进变化过程

在第5到12章中，我们介绍了若干基本的咨询技能。在第17到28章中，我们将讨论可以与这些基本技能结合使用的附加技能。在本章中，我们将探讨如何将所有这些咨询技能综合成一个顺序过程，以最大限度地提高产生变化的可能性。在探讨这一过程时，我们需要认识到每次咨询都是独特的；没有两次咨询干预会完全相同。然而，经过长时间的咨询实践后，许多咨询师发现咨询过程中存在一种常见的模式。图16.1中的流程图以图表形式展示了这种模式。尽管这个流程图有助于理解常见咨询过程的各个阶段，请注意图表中描述的各个阶段通常会重叠、重复，并且出现的顺序可能与图中所示不同。

主要咨询技能

图16.2展示了特定的咨询技能如何融入从联合阶段开始到结束阶段结束的过程。你可能会注意到，在图的中心有一个名为“主要咨询技能”的框架。我们认为联合和倾听、内容转述和情感反映是主要的咨询技能。我们认为这些技能是所有咨询技能中最重要和最有用的，因为它们可以在咨询过程中的任何点有效使用。因此，我们将“主要咨询技能”框架放在图16.2的中心，以强调这些技能适用于咨询过程的所有阶段。这些主要咨询技能已在第5到8章中进行了详细描述。我们认为在咨询的早期阶段应几乎独家使用这些技能。然而，它们在整个咨询过程中也应适时使用。需要注意的是，联合不仅仅发生在关系的开始。如果我们不认真对待与我们试图帮助的人的联合方式，我们的联系可能会受到影响。我们需要不断关注联合过程。另外，在咨询的各个阶段，寻求帮助的人感到被听到和理解是非常重要的。确保这一点的最佳方法是通过内容转述和情感反映。

图16.1 咨询过程的阶段

咨询师的过程	寻求帮助者的过程	咨询过程的阶段
准备		准备
联合		联合
主动倾听		主动倾听
强调情感		强调情感
强调思维	（澄清问题）	强调思维
强调思维	（重构思维）	强调思维
强调行为		强调行为
结束		结束

图16.2 技能在咨询过程各阶段的相关性

强调情感	主动倾听	强调思维（澄清问题）	主要咨询技能	联合	邀请对方讲话	联合和倾听技能	内容转述	情感反映	总结	提问的使用	使用“此时此刻”的体验	正常化	对质	强调思维（重构思维）	结束	总结	如有必要签订合同	给予积极反馈	强调行为	探索选项	促进行动	挑战自我破坏性信念	解决方案聚焦技能	外部化	探索两极性	重新框定

本章知识点阐述

进一步阐述知识点

综合技能以促进变化过程

1. 基本咨询技能的介绍：

   • 第5到12章：介绍了若干基本的咨询技能，如倾听、情感反映、内容转述等。
   • 第17到28章：将讨论可以与这些基本技能结合使用的附加技能，如解决冲突、目标设定等。

2. 咨询过程的综合：

   • 顺序过程：将所有这些咨询技能综合成一个顺序过程，以最大限度地提高产生变化的可能性。
   • 独特性：每次咨询都是独特的，没有两次咨询干预会完全相同。
   • 常见模式：经过长时间的咨询实践后，许多咨询师发现咨询过程中存在一种常见的模式。

3. 主要咨询技能：

   • 定义：联合和倾听、内容转述和情感反映被认为是主要的咨询技能。
   • 重要性：这些技能是最重要和最有用的，因为它们可以在咨询过程中的任何点有效使用。
   • 适用性：这些技能适用于咨询过程的所有阶段，特别是在咨询的早期阶段应几乎独家使用。

4. 咨询过程的阶段：

   • 准备：咨询师和寻求帮助者为咨询做好准备。
   • 联合：建立良好的咨询关系。
   • 主动倾听：通过倾听和反馈建立信任。
   • 强调情感：帮助寻求帮助者表达和处理情感。
   • 强调思维：（澄清问题）帮助寻求帮助者明确问题所在。
   • 强调思维：（重构思维）帮助寻求帮助者改变思维方式。
   • 强调行为：帮助寻求帮助者采取具体的行动。
   • 结束：总结咨询过程，确保寻求帮助者感到满意。

5. 技能在各阶段的应用：

   • 强调情感：情感反映和内容转述，总结。
   • 主动倾听：内容转述，情感反映，总结。
   • 强调思维：（澄清问题）内容转述，情感反映，总结，提问的使用，使用“此时此刻”的体验，正常化，对质。
   • 强调思维：（重构思维）总结，如有必要签订合同，给予积极反馈。
   • 强调行为：探索选项，促进行动，挑战自我破坏性信念，解决方案聚焦技能，外部化，探索两极性，重新框定。

通过这些内容，本书旨在帮助读者理解如何综合各种咨询技能以促进变化过程，并在实际工作中应用这些理论和方法。这些知识不仅提高了咨询师的专业能力，还增强了他们在实际工作中的应用效果。

STAGES OF THE COUNSELLING PROCESS l he stages of a counselling process, as listed in the right-hand column of Figure 16.1, will be discussed in the following paragraphs. While reading this discussion it might be helpful to refer to both Figure 16.1 and Figure 16.2. PREPARATION l he counselling process starts even before the person seeking help and the counsellor meet. Often, when a person is on their way to a counselling session they will think about and rehearse what they intend to say. They are likely to bring with them preconceived ideas about what’s going to happen in the counselling session. They will have not only expectations but probably considerable apprehension too. Coming to a counselling session can be quite difficult for many people because it is painful to talk about deep inner feelings, and it may be threatening to do this with a stranger. The counsellor's own experience Counsellors also bring their own expectations, agendas and personal feelings to counselling sessions. As discussed in Chapter 1, a counsellor’s expectations and agenda may be different from those of the person seeking help. Also, it is possible for the counsellor’s personal feelings to intrude on the counselling process to the detriment of the person seeking help. Certainly the counsellor’s own attitudes, beliefs and feelings are likely to influence what happens in the session. If counsellors have personal problems of their own that are unresolved and currently troubling them, these may well affect their counselling. Obviously, it is very important for counsellors to try7 to minimise the intrusion of their own issues into the counselling process. One of the best ways for counsellors to achieve this is for them to become as aware as possible of their own personal troubling issues, and to stay in touch with what they are experiencing internally during each counselling session. We believe that if, when counselling, you deliberately take notice of what is happening within yourself, then you will be better able to deal appropriately with what is yours, and to separate that from what belongs to the person seeking help. In this way your own issues will be less likely to intrude on the counselling process. When you do notice that yrour own issues have intruded it is essential to talk through these with your supervisor. Information gained prior to counselling Before a counsellor has met with the person seeking help, it is likely that they7 may have some preconceived ideas about the person. Often the counsellor will have information about them before the session starts. This information may have come from the person or agency that referred the person for counselling. David has admitted that as a new counsellor he believed that such material often distorted his own understanding of the person. Consequently, he went through a stage of trying not to listen to what referral sources told him. He would make an appointment and say to the referral source: 4I’ll find it all out from John (the person seeking help)’, fortunately, he has changed that approach because he discovered that quite often a referral source would have factual information that would be useful in enabling him to understand the person more fully, and which might take time to come out in the counselling session. Additionally, some people coming for counselling will expect that a referral source will have provided information.

JOINING As discussed in Chapter 5, joining is the stage where the person seeking help and the counsellor meet and a relationship is established, so that the person feels at ease. Also, at this time the counsellor may be able to check out and adjust some of their preconceptions about the person. During the joining stage the relevant counselling micro-skills are the primary counselling skills: the joining and listening skills described in Chapter 5, together With paraphrasing content and reflection of feeling as described in Chapters 6 to 8. Although one or two questions may be needed, we recommend that the use of questions should be kept to a minimum at this stage in the process. However, in the initial settling-in period it may be useful to check out how the person is feeling by asking, Tm wondering how you are feeling right now7 This brings the focus onto the person’s current awareness and enables them to get in touch With their own anxiety or tension about coining for counselling. By helping them to get in touch with these feelings, the feelings may change so that the person feels more at ease as they start to talk about troubling issues. Sometimes a person will come with a 'shopping list’ of things that they wish to talk about, and may even produce lengthy handwritten notes. When someone who comes to see us does this, we try to help them feel that what they have done is useful and valuable preparation. However, we avoid getting trapped into working through the shopping list item by item, and instead use the list to generate Energy in the person. For example, we might say, 4 I his list is really important. When you think about it, what do you think about first?’ This enables the person to find a starting point from which to proceed naturally, in whatever direction their energy takes them. More often than not the shopping list will become irrelevant as more important underlying issues emerge.

Clarifying the counsellor's role Unfortunately some people perceive counsellors as experts with almost magical skills, who are capable of using clever psychological techniques to solve other people’s problems. Consequently, there may be a need for you, the counsellor, to explain exactly how you do see yourself. For example, you might say: Look, I don't see myself as an expert who can solve your problems for you. In fact, I believe that you will always know and understand yourself better than I will know and understand you. However, I hope that in this session you and I together can explore what s troubling you so that you can make some progress towards feeling more comfortable. Alternatively, you might say something like: It would be great if I were a magician who could wave a wand over you to solve your problems. I can't do that, but I can offer you the opportunity to come here and explore your problems with me in a safe and confidential setting. Hopefully, by doing that, you will start to feel more comfortable.

ACTIVE LISTENING During the active listening stage a counsellor will usually rely mainly on paraphrasing, reflection of feeling and summarising. Once again, although it may be necessary to ask one or two questions, it is preferable for these to be kept to a minimum. As the person starts to talk about their issues, the counsellor can respond by using minimal responses, paraphrasing and reflecting feelings. By doing this the person is encouraged to disclose what is troubling them, in their own way and at their own pace, and without unnecessary intrusion into that process by the counsellor. Consequently, the person’s story unfolds and the relationship between them and the counsellor develops as the person feels valued by the counsellor’s active listening. Through the counsellor’s paraphrasing and reflecting, the person can gain an assurance that the counsellor has both heard and understood them. During the active listening stage, while keeping a check on their own inner experiences, counsellors need to focus their energy by concentrating as fully as they can on what is happening inside the counselling room. In particular, they need to fully attend to the person, to concentrate on listening to and observing them, and to sense what they are experiencing. This is not always easy and there will inevitably be occasions when a counsellor’s attention does wander through an intrusion in the counselling environment, the presence of intrusive thoughts, over-tiredness, or for some other reason. If this does happen it may be best to be open and honest with the person and then to re-focus on the counselling process. Remember that no one is perfect. It you are starting to become over-tired you might like to read Chapter 42, which is entitled ‘Looking after yourself.

EMPHASIS ON EMOTIONS During this stage the counsellor will use reflection of feelings in order to help the person get in touch with their emotions. Clearly, this needs to be done in the context of the information that is being disclosed. It follows that in addition to using reflection of feelings the counsellor needs to make use of paraphrasing and summarising. New counsellors need to be aware that during this stage of the counselling process it is likely that people who are experiencing high levels of distress will get in touch with, and express, strong emotional feelings. While continuing to be empathic, the counsellor needs to remain grounded because, inevitably, if they are joined with the person, they will experience emotional feelings themselves. Although some counsellors believe that it is useful for them to fully experience the emotional feelings of the person seeking help, we think that there are dangers in doing this. For example, imagine that they start to cry. If the counsellor were also to start to cry, the person might become concerned and believe that what they were telling the counsellor was too hard for the counsellor to hear. Rather than focusing on their own problem, the person might become more concerned about the counsellor and want to nurture them. Clearly, this would not be useful. We think that, when counselling, if someone starts to cry it is important not to interrupt that process, but to allow them to cty and express the emotion so that cathartic release can occur. In our view, it is most useful if the person believes that they can share their innermost thoughts and feelings with a counsellor who is able to listen calmly and dispassionately but empathically. Some people will find this difficult to do as they believe that being dispassionate is incompatible with being empathic. We don’t see it that way. We think that when we are able to remain grounded so that our own emotions are contained we are able to show the person warmth and empathy without interrupting their need to fully express their emotions without unnecessary constraint.

It certainly can be difficult at times for a counsellor to contain their own emotions during counselling sessions when they are listening to someone who is very distressed. We ourselves find that at times we leave a counselling session feeling strong emotions of our own as a result of what we have heard. When this happens we are careful to make sure that we debrief by talking with another counsellor or with our supervisor (see Chapter 41). Respecting the pace of the person seeking help In the early stages of counselling it is common for a person to be unable to recognise and talk about their emotional feelings. 1 hey may want to talk about things ‘out there’ rather than get m touch with their inner experiences. 1 hey may want to talk about other people’s behaviour, and about other people’s fears. 1 hey may want to focus on what has happened in the past rather than on the present, and to focus on events instead of on their own inner feelings. In this situation it can be useful to encourage the person to focus on their inner feelings and thoughts, as they are in the present. However, it is also important not to pressure the person but to allow them to move at their own pace. At first, it is appropriate to respect the person’s need to talk about the ‘out there’ things as it may be too painful for them to focus on their own inner processes. With time, as they deal with the 'out there’ problems and the ‘out there’ situations, they are likely to move slowly towards recognising and talking about their own feelings from the past. This is because past feelings will probably not be as threatening as present feelings. Later, they may feel more able to own their current feelings and move towards experiencing them. Take time in helping the person to experience their own thoughts and feelings in the present. It is important to do this sensitively because they need to be able to gradually approach the painful parts of their life, rather than be pushed into doing this too quickly. Allowing them to begin exploring their most painful emotional experiences at a pace that suits them minimises the possibility that they may avoid fully exploring the emotional feelings that are troubling them. EMPHASIS ON THOUGHTS - CLARIFYING THE PROBLEM During this stage of the counselling process, as explained previously, the counsellor needs to continue using the primary counselling skills as at all other times during the process. However, a number of additional skills are now needed. As the person’s trust; develops, the counsellor will be able to ask appropriate questions where necessary in order to help them move forward and identify the most pressing problem. The counsellor needs to be active both in using questions and in summarising to help the person clarify their problem. Important parts of what they have said need to be drawn together by summarising these to help the person focus more cl early- Once the problem is clearly identified, depending on its nature, it is often helpful in clarifying it to make use of one or more of the skills described in Chapters 17 to 19; that is, the skills of normalising, using the ‘here and now’ experience and confronting. EMPHASIS ON THOUGHTS - RESTRUCTURING THOUGHTS During this stage of the counselling process there are some additional skills that are particularly useful in promoting change. These are the skills of challenging self­ destructive beliefs, externalising, solution-focused skills, exploring polarities and re framing, which will be discussed in Chapters 20 to 24. One or more of these skills can be selected and used to encourage the person to choose more constructive belief's and ways of thinking about their problem. EMPHASIS ON BEHAVIOUR The counsellor may now be able to assist the person to move forward into exploring options, resolving dilemmas and planning for action using the skills discussed in Chapters 25 and 26. However, it is important to ensure, as stated previously, that the person does not feel pressured. It is important to focus on raising their awareness of their present situation rather than pushing for choice or action. To encourage a person to make a choice prematurely will pressure them, and will make it harder for them to reach a decision. If they are not ready to make a choice, they must be allowed to feel that it is OK to be unable to make a decision, and it is OK to remain stuck for the present.

CLOSURE A good way to close a counselling session is to summarise important personal discoveries that have emerged during the session. Generally, it is better to pick out what was important in a session rather than to attempt to summarise everything covered in the session. At the close of a session you might wish to imagine that when the session began the person brought into the room an awkward bundle of thoughts and feelings. They then dropped the bundle onto the floor and started to examine the contents one at a time. After examining each item, some were retained, some were thrown away and others were exchanged. After that the person needed help to tie up the bundle into a neater, more manageable package. A counsellor can provide such help by using a summary’ to tie together important themes which have emerged during the counselling process. It is important to remember, using the metaphor of the bundle, that the bundle belongs to the person seeking help, so it must be their decision about how and when they complete their repackaging. Respecting the person's process Sometimes a person will not be ready to tie up the package. Sometimes they will be left in a very uncomfortable space, feeling stuck, unhappy or distressed about what they have discovered during the counselling process. Many counsellors, especially new ones, want the people who seek their help to leave sessions feeling happy. However, it is important to remember that often it is useful for a person to be able to spend time between counselling sessions mulling over what has been discussed in the counselling session so that they can absorb and make sense of it before coming back again, if they need to. It can be distressing for a new counsellor when someone who arrived for a counselling session looking composed leaves the session showing signs of emotion. 1 his will inevitably happen at times because if a counsellor is effective the person may move into areas that previously had not been openly explored. Consequently, they may feel the pain of experiencing emotions that had been suppressed and leave the counselling session exhausted and sad. Sometimes allowing the person to do this can be therapeutic and the positive results of this process may be seen when they return for a subsequent session. However, if the counsellor suspects that a person may engage in self-harming behaviour as a consequence of raised emotions, then appropriate action needs to be taken (see Chapters 34 and 40).

IN CONCLUSION 1 he process of a counselling session described in this chapter gives an overview of the way that various counselling micro-skills can be used at different stages of the counselling process. However, we hope that, as a counsellor, you won't attempt to follow this process rigidly, but rather will allow the process to emerge naturally. As explained previously, the stages of the counselling process described in this chapter and illustrated in Figures 16.1 and 16.2 do not necessarily occur sequentially; not only may they overlap, but at times the process will return to an earlier stage before continuing. Consequently, it is sensible to do as described in Chapter 2: that is, to allow the person to go at their own pace, in their own direction and to feel as though they are going on a journey with you, the counsellor, walking alongside. In this process, you will at times use your skills to enable the person you're helping to continue on a journey in a useful way. If you do this, the counselling process will occur naturally, smoothly and without great effort on your part. Most importantly, the person will be undergoing a process of growth which may enable them to lead a more fulfilling and less painful life.

Learning summary The typical stages in a counselling session are described schematically in Figure 16.1. Skills used at each stage in the counselling process are illustrated in Figure 16,2. The expectations, agenda and personal feelings of both the person seeking help and the counsellor will affect the helpfulness of a counselling intervention. Counsellors don't pretend to have magic wands! Initially people seeking help often want to talk about tilings 'out there', other people and past events, rather than focus on their own inner feelings and thoughts. After a person has talked about their problem, allow them to explore and express their emotions, then help them to clarify the problem and restructure their thoughts. Finally, help them to explore their options and make decisions regarding their future actions. Further reading Ivey, A.E., Ivey, M,B. & Zalaquett, C.P. 2015, ‘Skill integration through examining your own session, treatment plans, and case management’, in A.E. Ivey, M.13. Ivey & C.P. Zalaquett, Essentials of Intentional Interviewing: Counselling in a Multicultural World, Cengage Learning, Boston, pp. 256—71.